Gingival Anaplastic Large-Cell Lymphoma Mimicking Hyperplastic Benignancy as the First Clinical Manifestation of AIDS: A Case Report and Review of the Literature
This paper presents an unusual case of gingival ALCL, which mimicked a benign hyperplastic lesion that occurred in a 57-year-old white man representing the first clinical manifestation of acquired immunodeficiency syndrome (AIDS). The patient was referred to the Dental Clinic of PUCPR complaining of a lobulated nodule on the gingiva of his upper central incisors. The presence of advanced chronic periodontitis and dental plaque raised suspicion for a benignancy. An excisional biopsy was performed, and large pleomorphic cells with an abundant cytoplasm, sometimes containing prominent nucleoli and “Hallmark” cells, were observed through hematoxylin and eosin staining. The tumor cells showed strong CD30 expression, EMA, Ki-67, and LCA, and negative stain for , CKAE1/AE3, CD20, CD3, CD56, and CD15. The final diagnosis was ALCL (ALK-negative). Further laboratory tests revealed positivity for human immunodeficiency virus (HIV). The patient was submitted to chemotherapy, but four months after diagnosis, the patient died due to pneumonia and respiratory failure. Oral anaplastic large-cell lymphoma (ALCL) is a rare disorder. Only 5 cases involving the gingiva have been reported, and to our knowledge, this is the first case reported of the ALCL, which mimicked a hyperplastic benignancy as the first clinical manifestation of AIDS. 1. Introduction Malignant lymphomas (MLs) are a large group of neoplasms affecting the lymphoid system and are subdivided into two main groups: Hodgkin’s and non-Hodgkin’s lymphomas (NHLs) [1]. ML is considered an opportunistic neoplasm because it frequently affects immunocompromised patients. The prevalence of ML has increased considerably with improved acquired immune deficiency syndrome (AIDS) survivorship [2, 3]. NHLs appear in 3% of HIV-seropositive patients [4]. The NHLs may be present outside the lymphoid system, in which case they are called extranodal [5]. This type of lymphoma is located at an extranodal site in 40% of cases [5] and its extranodal presentation occurs in almost 75% of human-immunodeficiency-virus- (HIV-) seropositive patients [2]. Furthermore, only 2% to 3% of these extranodal cases occur in the oral cavity [6]. In the group of NHLs, mature T cell and natural killer (NK) cell neoplasms make up only 12% of NHL cases worldwide [1]. Within this heterogeneous category, anaplastic large-cell lymphoma (ALCL) is found [7, 8] and is listed in the Revised European-American Classification of Lymphoid Neoplasms (REAL) as an independent entity [9]. A couple of ALCL cases have been reported, although some were the B-cell
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